Covid-19: in South Sudan, a campaign to “bring the vaccine closer to the people”

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Agnes Lazarus, a resident of Ibba village, South Sudan, attends the launch of the Covid-19 vaccination campaign on October 27, 2021.

On this radiant day at the end of October, an event is brewing in the middle of the small market in Ibba, a green village in the state of Western Equatoria, in South Sudan. As with weddings and funerals, marquees were erected. Loudspeakers play a catchy song, whose lyrics in the local language, Zande, invite you to protect yourself against what is commonly called the “corona”. That day must finally begin vaccination against Covid-19 in this remote county that has not benefited from the two previous campaigns launched in the country. And this while barely 0.3% of the 11 million South Sudanese are now fully vaccinated against SARS-CoV-2.

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For the health authorities of this country, the youngest in the world (it became independent in 2011) and one of the least developed, the challenge is as much to deliver the available doses to the most isolated areas as to convince people to get vaccinated. In Ibba, the hundred or so plastic chairs lined up under the white tents remain empty. Shyness? Mistrust ? The inhabitants of the village stay away, in the shade of the large mango trees or under the fronts of red brick shops. However, the event in preparation is a real eye-catcher.

Agnes Lazarus came with her backpack without really knowing what was going on. « I live near here, I heard the announcements, we were talking about an initiative about the corona. I arrived very early this morning and now I’m hungry », she complains, sitting on a big root, as the program is hours behind schedule.

Tenacious rumors

In September, nearly 153,000 doses of the Janssen vaccine, from the Johnson & Johnson laboratory, arrived in South Sudan via the Covax initiative, a World Health Organization (WHO) program supposed to provide vaccines to the most vulnerable countries. less rich. Thanks to this stock, a new strategy provides for “Reduce the gap between rural and urban, as well as between men and women”, explains Dr Anthony Lomoro, from the NGO World Vision, partner of the authorities for vaccination in Western Equatoria (south).

In early October, for example, only a quarter of South Sudanese vaccinated were women. The result, among other things, of persistent rumors, such as that predicting their infertility in case of injection. In addition, the vaccine had so far only been available in large hospitals and some counties had been excluded from its distribution.

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Thus, for this third phase of the campaign, « it is about bringing the vaccine as close as possible to people ”, summarizes Seth Kpaka Parakiti, a WHO representative. Motorcycles have even been chartered to access the most remote vaccination sites. And alongside the 156 vaccinators trained for the operation in Western Equatoria, 440 “local health promoters” have been recruited to fight disinformation and prepare the ground. To finance everything, the United States Agency for International Development (Usaid) disbursed 1.5 million dollars (about 1.3 million euros).

In Western Equatoria, it is in Yambio, the regional capital, that the 8,475 doses of the vaccine allocated to this vast territory are centralized. To reach Ibba, 100 km further east, the precious vials were placed in coolers then loaded into pick-ups capable of facing the laterite track where countless trucks get stuck, trapped in the nests. hen filled with mud.

Intoxicated schoolgirls

It was also by this grueling road that a delegation made up of representatives of the Ministry of Health and World Vision arrived to inaugurate the vaccination in Ibba. A trip that allowed them to confront the reluctance of local populations. Here, they are closely linked to a serious incident that occurred in early October, when 175 schoolgirls were severely intoxicated following the administration, at the initiative of the Ministry of Health, of a powerful dewormer against bilharzia.

« We still haven’t received an apology or an explanation for what happened to our daughters, and now you come back with a vaccine? », Marona Sako Faustino, Ibba’s supreme leader, gets angry during an impromptu meeting at the county commissioner’s premises. “The community should be consulted to decide whether or not corona vaccination should begin. We leaders will not mobilize people and we do not want to be responsible if someone dies ”, he asserts in front of his dumbfounded interlocutors. “Covid-19 is a fatal disease, you have to protect your community », replies John Sangara, from the Department of Health. Even though they are most likely underestimated, the numbers remain low in South Sudan, with 133 dead since the start of the pandemic.

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Back in the marketplace, officials received their injection in public to urge residents to do the same. Places are expensive, with an estimated eligible population of 25,000 and only 500 doses allocated to the county. Marona Sako Faustino is in no hurry. “I will see how those who take their vaccine react. And if all goes well, I’ll go get mine in a few days ”, said the village chief after returning to his offices in Ibba’s small court of law.

” People are scared “

Enemies or allies of vaccination, more or less respected, traditional leaders have been the “influencers” of communities since the dawn of time. Charles Gian, traditional chief in Maridi, 40 km from Ibba, has long been a supporter of vaccination campaigns. “I have already done this work for polio, measles, tetanus… We go around the houses and we fight against the influence of traditional doctors, who can delay the care of patients in the hospital. “ This time he plans to “Explain the difference between vaccines, the fact that people who have received AstraZeneca cannot receive Johnson & Johnson, they have to wait for their second dose, like me! “

During the Covid-19 vaccination campaign at Maridi Hospital, South Sudan, October 29, 2021.

In Maridi, a city of some 20,000 inhabitants, the Covid-19 killed four people, unlike Ibba, where no case has been officially identified. But despite this more tangible reality of illness, “Nobody here is interested in this vaccine, especially not the women”, observes Sarah Benneth Gugu, director of the Maridi women’s association. According to her, “People are afraid of the vaccine and of the hospital”.

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Desperate acts have thrilled this village located between Yambio and Juba. Like the flight of a person who tested positive for Covid-19 to the country’s capital, in the hope of obtaining better care, and who never returned. Or the attempt by a family to forcibly retrieve the body of a corona victim from the hospital for a traditional funeral – a business that police intervention failed.

At James Benson Mohamed Kporube, director of the charity Africano Mande Foundation, fear of the virus outweighed that of the vaccine. Two days after the opening of the vaccination campaign, he crossed the gate of the Maridi hospital and took his place on the bench where a few other injection candidates were waiting. Touched by “The cough epidemic” which swept over Maridi in August and September, he wanted at all costs to seize the opportunity to receive a first dose. “I was coughing and it hurt all over. I was very scared and I thought about the Covid, because my wife, who had already been vaccinated, had nothing at all », he confides while waiting his turn.

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Covid-19: in South Sudan, a campaign to “bring the vaccine closer to the people”